EMCrit Project

. Introductory case . A young 70-kg man was transferred to the Genius GeneralICU for management of stupor.  He had been diagnosed with aortic valve endocarditis due to heroin abuse two weeks earlier, but left the hospital against medical advice.  Shortly after admission to Genius General, the lab called with a critical sodium value of […]

. An elderly man was admitted to the ICU and evaluated by six blind physicians. . The blind cardiologist noted that the patient had a malignant pericardial effusion with tamponade.  She recommended an immediate pericardial drain followed by intra-pericardial chemotherapy. . The blind oncologist noted that the patient had stage IV lung cancer.  He recommended […]

  . Case example . A previously healthy 45-year-old man was transferred to the Genius General Hospital ICU for management of pneumonia.  He was intubated prior to transfer due to hypoxemia (details unavailable).  His chest radiograph showed dense right lower lobe consolidation, which was confirmed with ultrasonography.  He was treated with a regimen of dexamethasone, […]

Introduction  . Community-acquired pneumonia (CAP) remains the leading cause of infectious disease death in developed countries.  Described by Sir William Osler as “captain of the men of death,” it dates back to antiquity.  However, we are only beginning to understand the best ways to treat it.   . Part 1:  The Pneumococcal meningitis story . Ceftriaxone […]

Introduction with a case . A 45-year-old man was transferred to the Genius General Hospital ICU for management of pneumonia.  His chest radiograph is shown above.  Chest ultrasonography showed extensive consolidation of the entire right lower lobe with dynamic air bronchograms (video below).  He was treated with ceftriaxone and azithromycin.  . Extensive lobar consolidation with […]

. Introduction . Suppose you just placed the central line shown above.  Does it need to be repositioned?  . I was trained that the tip of the central line must lie in the lower portion of the superior vena cava.  If the line was in the right atrium, it would cause cardiac perforation.  If the […]

. Introduction . In 2012 a NEJM article by Ray et al. reported a correlation between azithromycin and cardiovascular death.  This received extensive press and ultimately led the FDA to issue a drug safety communication warning about the risk of QT prolongation and torsade de pointes.  Subsequent studies have failed to replicate this result.  Nonetheless, […]

. . Introduction . The Surviving Sepsis Campaign has raised awareness that septic shock is a medical emergency.  However, these guidelines recommend a stepwise approach to resuscitation, which commonly results in a gradual escalation of treatment intensity.   Additional therapies are added over several hours if the patient fails to reach treatment goals.  For some patients, […]

Introduction 0 The utility of steroids in sepsis has been debated passionately for decades.  There is hope that steroids might improve mortality, but also fear that they could increase infectious complications.  Practice varies widely.  What does the data truly indicate? 0 Four misconceptions and one truth 0 Misconception #1: Stress-dose steroids decrease mortality 0 This […]

Introduction with a case 0 Once upon a time a 60-year-old man was transferred from the oncology ward to the ICU for treatment of neutropenic septic shock.  Over the course of the morning he started rigoring and dropped his blood pressure from 140/70 to 70/40 within a few hours, refractory to four liters of crystalloid. […]

Introduction 0 A post two months ago explored the use of CT angiography instead of tagged RBC scans for the evaluation of lower GI bleeding (here).  The algorithm below was developed based on evidence regarding the speed and performance of various tests.  However, there was no direct evidence validating this algorithm.  A new study from […]

0 Introduction 0 Until recently there has been little evidence regarding the caloric target for feeding critically ill patients.  In the absence of evidence, it has been assumed that we should aim to meet 100% of predicted energy needs.  New multicenter RCTs challenge this dogma, particularly the PERMIT trial by Arabi et al. 0 Theory […]